Friday, November 17, 2006

Food and the Corps of Discovery

Since the food theme is working out so well on this, the week before our American holiday of Thanksgiving, it seems only natural that today's lecture for the history of medicine elective course was Nutritional Lessons from the Corps of Discovery: the Lewis & Clark Expedition across the continent. Dr. William Connor and his wife Sonja Connor presented data on the nutritional aspects of the expedition, data which had been gathered primarily by premedical student Rachel Van Dusen before her departure for George Washington Medical School this fall.

An analysis of the nutritional intake of the Corps has apparently never been undertaken before, and it's easy to see why (and to see why the data gathering was left to a premed student): ten of the eleven volumes of the journals kept by Lewis and Clark, as well as journals kept by four other members of the expedition, were meticulously combed, day by day, for information on what the group ate. A nutritional analysis was then performed, and estimates of exercise were compiled to determine energy expenditures for various legs of the journey.

Connor began by reminding the group of the medical training which Meriwether Lewis received under Benjamin Rush at the University of Pennsylvania. Dr. Connor had actually spent much time in the History of Medicine Room this past summer combing through our copies of some of Rush's works to determine what Lewis could have learned from Rush about nutrition and diet. Although Lind's experiments on scurvy had been conducted earlier, Rush seemed to have no knowledge of this work, and like his contemporaries, he had no knowledge of vitamins. Nutritional diseases such as pellagra, rickets, night blindness, survey, goiter, anemia, and gout were well described, but no remedies were known.

What did this mean for the Corps? Well, since it was a military expedition, they were provisioned as military men would normally have been, with the same provisions being carried by naval vessels. Primarly salt, lard, and carbohydrates, the provisions contained zero sources of vitamin C. In fact, the provisions only wound up providing the expedition with eleven percent of the calories they required on the journey. An additional 18 percent of calories came from the Indians they encountered along the way, while the vast majority--71 percent--came from hunting and gathering activities.

Of the three sources of food, only the diet provided by the Indians was well balanced. The Mandan-Hidatsa were agricultural tribes who provided them with corn, beans, and squash; the Shoshones were accomplished hunter-gatherers; the Nez Perce were masters in the preparation of camas bulbs; and the Tillamooks gave the expedition 300 pounds of whale blubber (an excellent source of vitamin C). The Corps as a whole consumed excessive amounts of protein, purine, sodium chloride, fat, and choloesterol (as Connor noted, it was in a sense an early Atkins diet!). As a result, Clark experienced a severe bout of what was probably gout, and the crew as a whole suffered greatly from diarrhea.

Even with the additional food provided beyond what the Corps had carried with them, they experienced caloric deficits (based on the Connors' analysis) of 2915 calories per day on the trip west over the Bitterroots and a deficit of 3222 calories, again per day, on the return trip. Clearly, without the food they received from the Indians, the expedition members would have starved to death.

Which brings us back to Thanksgiving. I hope you all have a good one, with plenty to be thankful for. I myself will be thankful for, among other things, an extended holiday. I'll be away from Historical Collections & Archives throughout next week, so check back on Monday November 27 for the next glimpse into the collections.... Enjoy!

Thursday, November 16, 2006

Wellcome Witnesses

I received an announcement today of the availability of publications from the Wellcome Witnesses program--not, as it may sound, a group of Protestant sectarians, but rather a series in which the Wellcome Trust Centre for the History of Medicine invites notable figures to discuss topics and events in 20th-century medical history. While the Centre itself is based in London, the speakers chosen for the various topics represent several nations.

The series is a sort of group oral history project, and the publications which result from each seminar are based on transcripts of the conversations between the participants. Much as in our own Oral History Project, the transcripts are sent to each speaker for editing and additional comments before the final version is prepared. Bibliographical references and biographical information about each participant are added, and the whole document is made available to researchers.

Now, even if you don't have the money for airfare to London, you can access the full text of these publications freely online. Each of the twenty-eight volumes has been mounted as a PDF file which can be downloaded, printed, saved, even shared with others via email.

Topics already covered show a bit of British bias (naturally, e.g.: Early heart transplant surgery in the UK or Clinical research in Britain, 1950-1980), but include many items of broader interest (e.g. Maternal care or Genetic testing).

While we have only undertaken a few "group" interviews for our oral histories (e.g., the trio of nurses from the 46th General Hospital, Ruby Hills, Kay Fisher Hilterbrandt, and Edith Moore Richards) we do have some themes that emerged from early conversations: World War II and the 46th General Hospital; Japanese-Americans during World War II; town-gown relations; and women in medicine are some examples. If you're interested to see what our interviewees have said about cardiothoracic surgery or clinical research, check out the Oral History Master Index on our website.

Wednesday, November 15, 2006

Oregon Dietetics Internship Program

Since we (ok, I) was just talking about the history of dietetics yesterday, it seems remarkably fitting that today I should have added subject headings to the finding aid for a new archival collection, the Oregon Dietetics Internship Program Collection (Archives 2006-007).

This lovely collection of materials was recently donated to us by Carolyn Ostergren, renal dietician, and Dorothy Hagan, current director of the program. One of the things in the collection is a scrapbook created by 1956 program graduate Kathleen Sharp, who passed the scrapbook to Dr. Hagan at the banquet for the 75th anniversary of the dietetic internship earlier this year.

From these materials, we learn that the dietetic internship program was one of the earliest training programs developed here at the university, having started in 1930. A major impetus for creation of the internship was the establishment, in 1929, of the Oregon Dietetic Association as a branch of the American Dietetic Association (which was itself first organized in 1917). This makes our program the oldest on the West Coast! The program has graduated some 725 dieticians in its 75-year history; the first graduate was Dorothy James Keane, from Pullman, WA, who went on to become the chair of professional education.

If you're interested in reading a short history of the program, you can take a look at Hagan's The Oregon Dietetic Internship Program: 60 years of success, or the updated version of this, covering the next 15 years, which is available as part of the archival collection.

Tuesday, November 14, 2006

Food and medicine, food as medicine

I had a chance this morning to spend a few minutes browsing through a new book on medieval food, borrowed through the Orbis Cascade Alliance consortium by a library colleague. The book, Food in medieval times by Melitta Weiss Adamson, includes a whole chapter on "Concepts of diet and nutrition," including medical concepts of foodstuffs and their role in the maintenance of good health.

Weiss notes that dietetics "was one of the main areas of study at medieval medical schools," and that humoral theory dominated the teaching and practice of the period. According to Weiss, the Greek concept of the four humors had first been applied
to food by the Arab physician Haly Abbas, whose ideas were later adopted and modified by European practitioners. High mortality rates experienced during the Black Death spurred publications on diet and health and provided an impetus for some scholarly works to be circulated among the lower classes.

The relationship between food and health has remained an area of interest in medicine ever since. Here in the historical collections, we have numerous 19th-century works which deal with diet. We also have several items relating to the history of dietetics here at OHSU in the PNW Archives collection. In the main library collections, we also have cookbooks by OHSU faculty Roy Swank (MS diet) and Bill and Sonja Connor.

Is it lunchtime yet?

Monday, November 13, 2006

Annual Trunkey Lecture

This morning, Dr. F. William Blaisdell, emeritus professor of surgery from UC Davis, delivered the fourth annual Donald D. Trunkey Lecture on "The medical and surgical advances during the Civil War." Dr. Blaisdell originally became interested in the history of the Civil War when he, as eldest son of an eldest son, inherited the family archive, including a war diary kept by his great-grandfather who served with the 12th New Hampshire regiment in that conflict. The great-grandfather was wounded at the Battle of Cold Harbor in 1864, and through the miracle of archival preservation, Dr. Blaisdell was able to learn the nature of his wounds, the treatment he received, and even in which building he was treated (Barracks 10).

The existence of these records of medical treatment from the Civil War was a major point of Dr. Blaisdell's talk: the compilation, post bellum, of the multi-volume Medical and surgical history of the War of Rebellion was, according to Blaisdell, the first major academic undertaking of the American medical establishment. It is filled with charts, tables, and lists of results from hundreds of thousands of cases showing, for example, that of 155 trephining operations, only sixty were successful. The comparative study was made to help determine best practices, e.g., for chest wounds: since no one dared enter the chest cavity (J.M. Carnochan's experience with a penetrating heart wound notwithstanding), the choice was between closing the wound or leaving it open to drain (and, actually, results seemed to be about the same for either course of action). Interestingly, these results from the medical corps of the North cannot be compared with treatments used by Southerners in the conflict: all of the medical records kept by the Confederate Army were burned in the great fire at Richmond.

One interesting fact from the talk, of which I was not formerly aware: it was the ban on use of "blue mass" for treatment of loose bowels among the men which was a primary factor in the court-martial of Surgeon General William Hammond, and his replacement by Joseph Barnes, in 1863. Pharmaceutical recall controversy even back in the 19th century!